Maternal Outcomes Associated with Planned Vaginal Versus Planned Primary Cesarean Delivery

 

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ABSTRACT

We compared maternal morbidity between planned vaginal and planned cesarean delivery. A university hospital's database was queried for delivery outcomes. Between 1995 and 2005, 26,356 deliveries occurred. Subjects were divided into two groups: planned vaginal and planned cesarean delivery. This was based on intent to deliver vaginally or by cesarean, despite actual route of delivery. Planned vaginal delivery included successful vaginal delivery and labored cesarean delivery intended for vaginal delivery. Planned cesarean delivery included unlabored and labored cesarean delivery and vaginal delivery intended for cesarean. Chart abstraction confirmed the delivery plan. Primary outcomes were chorioamnionitis, postpartum hemorrhage, and transfusion. Secondary outcomes were also measured. A subanalysis compared actual vaginal delivery, labored cesarean delivery, and unlabored cesarean delivery. There were 3868 planned vaginal deliveries and 180 planned cesarean deliveries. Planned cesarean delivery had less chorioamnionitis (2.2% versus 17.2%), postpartum hemorrhage (1.1% versus 6.0%), uterine atony (0.6% versus 6.4%), and prolonged rupture of membranes (2.2% versus 17.5%) but a longer hospital stay (3.2 versus 2.6 days). There were no differences in transfusion rates. For healthy primiparous women, planned cesarean delivery decreases certain morbidities. Labored cesarean delivery had increased risks compared with both vaginal delivery and unlabored cesarean delivery.

REFERENCES

• 1 Althabe F, Sosa C, Belizán J M, Gibbons L, Jacquerioz F, Bergel E. Cesarean section rates and maternal and neonatal mortality in low-, medium-, and high-income countries: an ecological study.  Birth. 2006;  33 270-277
  CrossrefPubMedGoogle Scholar
• 2 Betrán A P, Merialdi M, Lauer J A et al.. Rates of caesarean section: analysis of global, regional and national estimates.  Paediatr Perinat Epidemiol. 2007;  21 98-113
  CrossrefPubMedGoogle Scholar
• 3 Martin J A, Hamilton B E, Sutton P D Centers for Disease Control and Prevention National Center for Health Statistics National Vital Statistics System et al. Births: final data for 2005.  Natl Vital Stat Rep. 2007;  56 1-103
  PubMedGoogle Scholar
• 4 Martin J A, Hamilton B E, Sutton P D Centers for Disease Control and Prevention National Center for Health Statistics National Vital Statistics System et al. Births: final data for 2006.  Natl Vital Stat Rep. 2009;  57 1-102
  PubMedGoogle Scholar
• 5 Visco A G, Viswanathan M, Lohr K N et al.. Cesarean delivery on maternal request: maternal and neonatal outcomes.  Obstet Gynecol. 2006;  108 1517-1529
  CrossrefPubMedGoogle Scholar
• 6 National Institutes of Health state-of-the-science conference statement: Cesarean delivery on maternal request March 27–29, 2006.  Obstet Gynecol. 2006;  107 1386-1397
  CrossrefPubMedGoogle Scholar
• 7 Allen V M, O'Connell C M, Baskett T F. Maternal morbidity associated with cesarean delivery without labor compared with induction of labor at term.  Obstet Gynecol. 2006;  108 286-294
  CrossrefPubMedGoogle Scholar
• 8 American College of Obstetricians and Gynecologists . ACOG Committee Opinion No. 386 November 2007: cesarean delivery on maternal request.  Obstet Gynecol. 2007;  110 1209-1212
  CrossrefPubMedGoogle Scholar
• 9 Geller E, Wu J M, Jannelli M J, Nguyen T V, Visco A G. Neonatal outcomes associated with planned vaginal versus planned primary cesarean delivery.  J Perinatol. 2009;  , October 8 (Epub, ahead of print)
  PubMedGoogle Scholar
• 10 Allen V M, O'Connell C M, Liston R M, Baskett T F. Maternal morbidity associated with cesarean delivery without labor compared with spontaneous onset of labor at term.  Obstet Gynecol. 2003;  102 477-482
  CrossrefPubMedGoogle Scholar
• 11 Declercq E, Barger M, Cabral H J et al.. Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births.  Obstet Gynecol. 2007;  109 669-677
  CrossrefPubMedGoogle Scholar
• 12 Burrows L J, Meyn L A, Weber A M. Maternal morbidity associated with vaginal versus cesarean delivery.  Obstet Gynecol. 2004;  103(5 Pt 1) 907-912
  CrossrefPubMedGoogle Scholar
• 13 Nisenblat V, Barak S, Griness O B, Degani S, Ohel G, Gonen R. Maternal complications associated with multiple cesarean deliveries.  Obstet Gynecol. 2006;  108 21-26
  CrossrefPubMedGoogle Scholar
• 14 Wax J R. Maternal request cesarean versus planned spontaneous vaginal delivery: maternal morbidity and short term outcomes.  Semin Perinatol. 2006;  30 247-252
  CrossrefPubMedGoogle Scholar
• 15 Benedetto C, Marozio L, Prandi G, Roccia A, Blefari S, Fabris C. Short-term maternal and neonatal outcomes by mode of delivery. A case-controlled study.  Eur J Obstet Gynecol Reprod Biol. 2007;  135 35-40
  CrossrefPubMedGoogle Scholar
• 16 Liu S, Liston R M, Joseph K S, Heaman M, Sauve R, Kramer M S. Maternal Health Study Group of the Canadian Perinatal Surveillance System . Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term.  CMAJ. 2007;  176 455-460
  CrossrefPubMedGoogle Scholar
• 17 Bailit J L, Love T E, Mercer B. Rising cesarean rates: are patients sicker?.  Am J Obstet Gynecol. 2004;  191 800-803
  CrossrefPubMedGoogle Scholar

Elizabeth J GellerM.D. 

University of North Carolina at Chapel Hill, Department of Obstetrics and Gynecology

CB #7570, Chapel Hill, NC 27599-7570

Email: egeller@med.unc.edu